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FORM OF BID OR PROPOSAL
F.Y. 2024 RAINBOW DRIVE RAILROAD CROSSING REPAIR
CONTRACT NO. 1108
CITY OF WATERLOO, IOWA
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
1. The undersigned, being a Corporation existing under the laws of the State of Iowa
a Partnership consisting of the following partners: ,,&uL()-n.: �,�.Q� ,,�L, PLC .
, having familiarized (himself) (themselves)
(itself) with the existing conditions on the project area affecting the cost of the work, and with all the contract
documents listed in the Table of Contents and Addenda (if any), as prepared by the City Engineer of the City
of Waterloo now on file in the office of the City Clerk, City Hall, Waterloo, Iowa, hereby proposes to furnish all
supervision, technical personnel, labor, materials, machinery, tools, appurtenances, equipment, and
services, including utility and transportation services required to construct and complete this F.Y. 2024
RAINBOW DRIVE RAILROAD CROSSING REPAIR, Contract No. 1108, all in accordance with the above -listed
documents and for the unit prices for work in place for the following items and quantities:
F.Y. 2024
RAINBOW
CONTRACT
DRIVE
RAILROAD
NO.
1108
CROSSING
REPAIR
ITEM
BID
IDOT
ITEM
NO.
ITEM
DESCRIPTION
UNIT
EST.
QTY.
UNIT
PRICE
BID
TOTAL
PRICE
BID
1
2102-2710090
EXCAVATION,
CLASS
10
-
WASTE
CY
30.0
$ 33.ob
$ 990,60
2
2105-8425005
TOPSOIL,
FURNISH
AND
SPREAD
CY
24.0
$ 51.00
$
1136$.00
3
2115-0100010
MODIFIED
SUBBASE
CY
15.0
$ 13.
00
$ id:
AS.ob
4
2301-1033060
STANDARD/SLIP-FORM
CLASS
3
DURABILITY,
6
INCH
PCC
PAVEMENT,
CLASS
C,
SY
43.3
$ '7�i.00
$ 3,
tog .20
S
2301-1033100
STANDARD/SLIP-FORM
CLASS
3
DURABILITY,
10-INCH
PCC
PAVEMENT,
CLASS
C,
SY
78.9
$
I
lo.
Do
$ t
tcn . Oo
6
2435-0600020
MANHOLE
ADJUSTMENT,
MINOR,
STORM
EA
1.0
$ 95-4.00
$ 9ft,
oo
7
2502-8212206
SUBDRAIN,
IN.
DIA.
STANDARD,
PERFORATED
PLASTIC
PIPE,
6
LF
46.0
$ 43.60
$
watt
8
2510-6745850
REMOVAL
OF
PAVEMENT
SY
230.3
$ 2.i
• oo
$ 4,
83L.10
9
2515-6745600
REMOVAL
OF
PAVED
DRIVEWAY
SY
63.0
$
I /.
eo
$
I
1
191. otD
10
2517-4225210
RAILROAD
APPROACH
SECTION,
PCC
SY
163.1
$
(I
1
. bo
$ 11,
on...70
11
2527-9263109
PAINT
MARKINGS,
SOLVENT
OR
WATER
-BOURNE
STA
3.46
$
1,4.
o0
$ 411. 24
12
2601-2636044
SEEDING
AND
FERTILIZING
(URBAN)
ACRE
0.015
$ 5b,e6e.
00
$ 70. co
13
2528-8445110
TRAFFIC
CONTROL
LS
1.0
$ 3, 600.00
$ ?jot. Ob
$ 2o4. oo
14
2528-2518000
SAFETY
CLOSURE
EA
2.0
$ I
b2.. 00
15
2529-2242304
CD
JOINT
ASSEMBLY
EA
2.0
$ 4I5•
Oo
$
930. 00
16
2533-4980005
MOBILIZATION
LS
1.0
$ Lis Soo. oo
$ y,S.O. 00
53 /37. AN
TOTAL
BID
FORM OF BID
CONTRACT NO. 1108
Page 1 of 3
13. The Owner reserves the right to select alternates, delete line items, and/or to reduce quantities prior
to the award of a contract due to budgetary limitations.
ED() 4 az_ CawribAcri ILL-C.
(Name of Bidder)
BY: CJ&v1O C SOPOU
Official Address: (Including Zip Code):
P-o. eo)( 3D to6 6 [sr. Sr
Title
5/1/20ZI/
(Date)
P. M . /&Mt-zc
Gaomiott C&rr&, LI- 16s8
I.R.S. No. 27 - 3072Je3
FORM OF BID
CONTRACT NO. 1108 Page 3 of 3
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of atiOL
County of 0:11/U,
�a.vvll Caps •oul ots
)ss
, being first duly sworn, deposes and says that:
1. He is (Owner, Partner, fficl Representative, or Agent) , of &xx476iC 6Lz!4tnSiaz4C
, the Bidder that has submitted the attached Bid;
2. He is fully -informed respecting the preparation and contents of the attached Bid and of all pertinent
circumstances respecting such Bid;
3. Such Bid is genuine and is not a collusive or sham Bid:
4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or
parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or
indirectly, with any other Bidder firm or person to submit a collusive or sham Bid in connection with the
Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such
Contract, or has in any manner, directly or indirectly sought by agreement or collusion or communication or
conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other
Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or
to secure through any collusion conspiracy, connivance, or unlawful agreement any advantage against the
City of Waterloo, Iowa, or any person interested in the Proposed Contract; and
5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion,
conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives,
owners, employees, or parties in interest, including this affia.
(Signed)
/aa
Title
Subscribed and sworn to before me this )NYVA A day of MI
Vintrw h
Title
14411Ch
My commission expires ') ' a. ()i
•
rtAZit t �� KIMBERLY D LYNCH
;
. r COMMISSION NUMBER 794278
MY OMMISSION EXPIRES
/OWP ) Lt
14 �vtH
Worksheet: Authorization to Transact Business
This worksheet may be used to help complete Part A of the Resident Bidder Status form. If at least one of the following
describes your business, you are authorized to transact business in Iowa.
O Yes ®No
Yes ®No
Yes
O Yes
O Yes ®No
® Yes
® Yes
0
Yes ®No
O Yes ®No
® Yes® No
O ves®No
My business is currently registered as a contractor with the Iowa Division of Labor.
My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
My business is a general partnership or joint venture. More than 50 percent of the general
partners or joint venture parties are residents of Iowa for Iowa income tax purposes.
My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution.
My business is a corporation whose articles of incorporation are filed in a state other than Iowa,
the corporation has received a certificate of authority from the Iowa secretary of state, has filed
its most recent biennial report with the secretary of state, and has neither received a certificate of
withdrawal from the secretary of state nor had its authority revoked.
My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed.
My business is a limited partnership or limited liability limited partnership which has filed a
certificate of limited partnership in this state, and has not filed a statement of termination.
My business is a limited partnership or a limited liability limited partnership whose certificate of
limited partnership is filed in a state other than Iowa, the limited partnership or limited liability
limited partnership has received notification from the Iowa secretary of state that the application
for certificate of authority has been approved and no notice of cancellation has been filed by the
limited partnership or the limited liability limited partnership.
My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
My business is a limited liability company whose certificate of organization is filed in a state other
than Iowa, has received a certificate of authority to transact business in Iowa and the certificate
has not been revoked or canceled.
309-6001 (09-15)
Bidder Status Form
To be completed by all bidders Part A
Please answer "Yes" or "No" for each of the following:
0 Yes ® No My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
0 Yes O No My company has an office to transact business in Iowa.
Yes ONo My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
0 Yes ONo My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
Yes • No My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in lowa.
If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please
complete Parts B and D of this form.
If you answered "No" to one or more questions above, your company is a nonresident bidder. Please
complete Parts C and D of this form.
To be completed by resident bidders Part B
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Dates: 0I / C)I / 2o2o to �S /a2 / 2024-/ Address: P6• B.W3"c £14 E 'rr. Sr.
City, State, Zip.G2v,vo y C6,�Ez, i 4. Sae Sg
Dates: / / to / / Address:
City, State, Zip:
Dates: / / to / / Address.
You may attach additional sheet(s) if needed. City, State, Zip.
To be completed by non-resident bidders Part C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor
force preferences or any other type of preference to bidders or laborers? 0 Yes Q No
3. If you answered "Yes" to question 2, identify each preference offered by your company's home state or foreign country
and the appropriate legal citation.
You may attach additional sheet(s) if needed.
To be completed by all bidders Part D
certify that the statements made on this document are true and complete to the best of my knowledge and I know that my
failure to provide accurate and truthful information may be a reason to reject my bid.
Firm Name: &ti2tt1 av7 'Titi6, zee:
Signature:
Date: J 2 Za2/
You must submit the completed form to the governmental body requesting bids per 875 Iowa Administrative Code
Chapter 156. This form has been approved by the Iowa Labor Commissioner.
309-6001 (09-15)
MBE/WBE BUSINESS ENTERPRISE
PRE -BID CONTACT INFORMATION FORM
Prime Contractor Name: &ut.D(r2 Cwrr /icri,vs
Project: t- `( 2624 RAiewso t t. R Fl C2eSs' rsi RePAi2 #Itos Letting Date:
5/2/zoi v
NO MBE/WBE SUBCONTRACTORS: If you are NOT using any MBE/WBE subcontractors to complete this project,
sign below. Attach a brief explanation as to why subcontracting was not feasible with this project. If any MBE/WBE
subcontractors will be used, please use the bottom portion of this form.
Contractor Signature: _
Title:
Date:
SUBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide
the information on this form showing ALL of your MBE/WBE subcontractor contacts made for your bid submission.
This information is subject to verification. Any questions may be directed to Contract Compliance Office 319-291-
4429.
You are required, in order for your bid to be considered responsive, to provide the information on this Form showing
your MBEl1NBE Business Enterprise contacts made prior to your bid submission. This information is subject to
verifications and confirmation.
If you are unable to identify MBE/WBE firms to perform portions of the work, please contact Rudy Jones, Contract
Compliance Officer, for assistance at (319) 291 4429.
In the event it is determined that the MBE/WBE Business Enterprise goals are not met, then before awarding the
contract the City of Waterloo will make a determination as to whether or not the apparent successful low bidder made
good faith efforts to meet the goals.
TABLE OF INFORMATION SHOWING BIDDER'S PRE -BID
MBE/WBE BUSINESS ENTERPRISE CONTACTS
Quotes
Received
Quotation
used
in
bid
Subcontractors
MBE/WBE
Contacted
Dates
Yes/No
Contacted
Dates
Yes/No
Dollar
Amount
be Subcontracted
Proposed
to
Xievtce
5;6,ut,
4 1291l q
Y�.)
5///24
Yer
j/flq.co
(Form CCO-4) Rev. 06-20-02
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Boulder Contracting, LLC
as Principal, and Westfield Insurance Company , as Surety, are held and firmly
bound unto the
CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum
Five percent of amount bid Dollars ($ 5% ) lawful money of
the United States, for the payment of which sum will and truly be made, we bind ourselves, our heirs, executors,
administrators, and successors, jointly and severally, firmly by these presents. The condition of this obligation is
such that whereas the Principal has submitted the accompanying bid dated the 2nd day of
May , 20 24 , for F.Y. 2024 Rainbow Drive Railroad Crossing Repair Contract No. 1108
NOW, THEREFORE,
(a) If said Bid shall be rejected, or in the alternate,
(b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form specified and
shall furnish a bond for his faithful performance of said contract, and for the payment of all persons performing
labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement
created by the acceptance of said Bid,
Then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly
understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed
the penal amount of this obligation as herein stated.
By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in liquidation of
damages sustained in the event that the Principal fails to execute the contract and provide the bond as provided
in the specifications or by law.
The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall
be in no way impaired or affected by any extension of the time within which the Owner may accept such Bid or
execute such contract, and said Surety does hereby waive notice of any such extension.
IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and such of
them as are corporations, have caused their corporate seals to be hereto affixed and these presents to be signed
by their proper officers this 2nd day of May , A.D. 2024 .
Boulder Contracting, LLC (Seal)
Witness
Witness
BID BOND
Westfield Insurance Company
Surety
By
Joseph I. $fhmit Attorney -in -fact
(Seal)
Page 1 of 1
THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME
POWER # AND ISSUED PRIOR TO 06/20/22, FOR ANY PERSON OR PERSONS NAMED BELOW.
General
Power
of Attorney
CERTIFIED COPY
POWER NO. 1429172 00
Westfield Insurance Co.
Westfield National Insurance Co.
Ohio Farmers Insurance Co.
Westfield Center, Ohio
Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO
FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company" and collectively as "Companies," duly
organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County, Ohio, do by these
presents make, constitute and appoint
JOSEPH I. SCHMIT, JEFFREY R. BAKER, GREG T. LAMAIR, E. A. VONHARZ, BRANDON HORBACH, JOINTLY OR SEVERALLY
of WEST DES MOINES and State of IA its true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred in its name,
place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of
suretyship in any penal limit. - -
LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE
GUARANTEE, OR BANK DEPOSITORY BONDS.
and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President, sealed with the corporate
seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in
the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the
WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY:
"Be It Resolved, that the President, any Senior Executive, any Secretary or any Fidelity & Surety Operations Executive or other Executive shall
be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for
and on behalf of the Company subject to the following provisions:
The Attorney -in -Fact. may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and
deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney -in -Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary."
"Be it Further Resolved, that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any
power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." (Each adopted at a meeting
held on February 8, 2000).
In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE
COMPANY have caused these presents to be signed by their National Surety Leader and Senior Executive and their corporate seals to be hereto
affixed this 20th day of JUNE A.D., 2022 .
Corporate ,•e' tUR�iii
�;,'•,
Seals O f,,......,,• .,t
Affixed = ��;' '�' •�ti• p'-
to
•ji
% i.
as '•..•.. a ,om
State of Ohio
County of Medina ss.:
': SE*'N•
,,H.•rllllll//
S '''
;, Cry t •9 ,ye,/
•• .a• ••
e
��HAATFRfp -,
3•
• ,ar.
1»4� **:•
/I
/fl,,/1111111t•�,•♦♦,
WESTFIELD INSURANCE COMPANY
WESTFIELD NATIONAL INSURANCE COMPANY
OHIO FARMERS INSURANCE COMPANY
B
Gary W. tumper, NationafSurety Leader and
Senior Executive
On this 20th day of JUNE A.D., 2022 , before me personally came Gary W. Stumper to me known, who, being by me duly sworn,
did depose and say, that he resides in Medina, OH; that he is National Surety Leader and Senior Executive of WESTFIELD INSURANCE
COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which
executed the above instrument; that he knows the seals of said Companies; that the seals affixed to said instrument are such corporate seals; that
they were so affixed by order of the Boards of Directors of said Companies; and that he signed his name thereto by like order.
Notarial
Seal
Affixed
State of Ohio
County of Medina ss.:
0
4 0
TE tttttt
David A. Kotnik, Attorney at Law, Notary Public
My Commission Does Not Expire (Sec. 147.03 Ohio Revised Code)
I, Frank A. Carrillo, Secretary of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS
INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said
Companies, which is still in full force and effect: and furthermore, the resolutions of the Boards of Directors, set out in the Power of Attorney are
in full force and effect.
In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 2nd day of
May A•D•, 2024
:t♦• U RA, ,'l'li
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Frank A. Carrillo, Secretary
Secretary
BPOAC2 (combined) (03-22)